The Path Home May Lead Through Extra Therapy, Study Finds

1/14/2016

Bill Myers

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Skilled
nursing therapy may cost money, but more than ever before, it’s helping people
get home, a new study claims.

In
what may be the first study of its kind, researchers from Cornell, Brown, and
Harvard examined the cases of nearly 482,000 Medicare patients who were
released from hospitals into skilled nursing centers after breaking their hips
between 2000 and 2009. They found that extra therapyimproved patients’ odds of getting straight
home. For every hour of extra therapy per week, a patient’s chance of being
discharged to home increased by more than 3 percent, the researchers say.

The
study, published in the January issue of Physical
Therapy—the peer-reviewed journal of the American Physical Therapy
Association—comes as regulators and some legislators are increasingly nervous
about the rising costs of skilled nursing services, and whether some skilled
nursing companies are more focused on their profits than on their patients.
The Medicare Payment Advisory Commission meets in Washington this week, for
instance, and is likely to continue its recommendations that regulators target
skilled nursing’s Medicare rates for a reduction in the amount of therapy the
government will pay for.

The
researchers here, led by Cornell professor Hye-Young Jung, found that while
costs have, indeed, risen dramatically since 2000, the average length of stay
has leveled off, and the ability of skilled nursing centers to get people
straight to home has also improved dramatically.

Outcomes Improved

In
2000, Medicare patients had a 71 percent chance of going straight home after
rehabbing their hips in skilled nursing centers. By 2009, the chances had
improved to 79 percent, Jung and colleagues say.

“Our
findings suggest that increasing the number of hours of therapy improves
outcomes for these patients, as reflected in the increased likelihood of being
discharged to home,” Jung writes for the team. “The results of our secondary
analysis indicated that this relationship was true for both occupational
therapy and physical therapy.”

Indeed,
at least one additional hour of occupational therapy per week improved a
patient’s chances of going straight home by more than 5 percent, and an
additional hour or more of physical therapy improved a patient’s chances of
going straight home by nearly 6 percent, Jung says.

Value, Not Cost

The
exception appears to be those hip fracture patients who suffered the worst impairments
and therefore had the lowest chances of getting home in the first place, Jung
and colleagues found. Nonetheless, the research team is hopeful that
legislators and policymakers will remember that the latest Washington vogue for
“value-based purchasing” is about “value,” not price.

Jung’s
findings are music to the ears of Dan Ciolek, the asociate vice president of therapy advocacy for the American Health Care Association/National Center for
Assisted Living. For more than two years, Ciolek and his colleagues have been
pushing back against what they see as arbitrary cuts to therapy services that
are focused solely on cost, not on value.

“We
agree 100 percent with the study’s conclusion that payment policy reforms
shouldn’t create disincentives to provide the intensity of therapy necessary to
patients who are likely to benefit from it,” he tells Provider. “There are better ways to ensure that patients get the
right care, at the right place, and at the right time."